A MULTIDISCIPLINARY AND MULTIDIMENSIONAL PROGRAM FOR HAND OSTEOARTHRITIS IS NOT EFFECTIVE: RESULTS OF A RANDOMIZED CONTROLLED STUDY

Background: Although research on the efficacy of non-pharmacological interventions is very limited and mainly based on low quality studies, international guidelines for management of hand osteoarthritis (OA) strongly recommend to treat all patients with hand OA with a combination of pharmacological and non-pharmacological interventions. The aim of this study was to examine the efficacy of a multidisciplinary, multidimensional nonpharmacological intervention in patients with hand OA. Objectives: To examine the efficacy of a multidisciplinary, multidimensional non-pharmacological intervention in patients with hand OA. Methods: A single blinded randomized multicenter trial was conducted. Patients were recruited at three Rheumatology outpatient clinics in the Netherlands. Included were patients with Hand OA according to the ACR classification Criteria for clinical hand OA with limitations in activities (AUSCAN function score ≥9). Patients were randomly assigned to immediate start of multidisciplinary intervention (four weekly sessions, including individual goal setting, exercises, education, and splints if considered necessary) or 30 minutes of education followed by waiting time of 3 months. Data at baseline and 3 months were collected by a research assistant who was blinded for treatment allocation. Primary outcome measures after three months were pain and limitations in activities as measured with the AUSCAN and the OARSI-20 responder criteria. Secondary outcome measures included grip strength, self-efficacy, pain coping and quality of life. (Dutch Trial Register trial number NTR1191). Results: 151 patients (83% female, mean (SD) age 59.2 (7.7)) were included. After 3 months no significant and no relevant differences were observed between the treatment group (n=76) and the control group (n=75) in any of the primary and secondary outcome measures. About one third of patients were classified as responder (OARSI 20 responder criteria) (32% and 37% in the treatment group and control group, respectively). Outcome: Measurement instrumentIntervention GroupDifference* (95% CI) at 3 months exp–contr Experimental GroupControl Group (n=76)(n=75) Baseline3 monthsBaseline3 months mean (sd)mean (sd)mean (sd)mean (sd) AUSCAN:  Pain10.4 (3.4)9.4 (2.8)10.2 (3.3)9.0 (3.7)0.40 (–0.50; 1.29)  Function21.0 (6.9)18.6 (7.3)21.8 (6.3)18.8 (6.4)0.49 (–1.01; 2.00)  Joint stiffness2.3 (0.9)2.2 (0.8)2.4 (0.8)2.1 (0.9)0.14 (–0.09; 0.37)  Assessment:49.5 (25.1)60.4 (20.6)51.3 (24.8)66.0 (20.6)–5.21 (-11.43; 1.01) *Adjusted for baseline. Conclusions: Patients with hand OA do not benefit from a multidimensional and multidisciplinary non-pharmacological treatment program on the short term. Future research should focus on the effectiveness of single treatment elements targeted on individual patient characteristics and needs Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 71, supplement 3, year 2012, page 729Session: HPR Abstract Session: Progress in rehabilitation – the future is bright (Oral Presentations )